Thursday, November 15, 2018

Bad Breathe and Palatal Expansion

How does Palatal Expansion RPE affect Halitosis (Bad Breathe)?

Halitosis can be a significant problem in teens and young adults; there are entire industries built on covering up bad breathe or providing products to improve oral hygiene. 

One of the many companies that focus product development for halitosis

Of course not brushing or flossing will lead to chronic bad breathe but did you know bad breathe can also be the result of certain combinations of malocclusion, poor airways and/or chronic inflammation of the nasal soft-tissue.  One of the more important factors in children can be a narrow maxilla.


These boys demonstrate a typical narrow maxilla with airway obstruction and chronic “mouth-breathing”.  Note the lip posture at rest being open, allowing the oral cavity to remain dry and preventing the natural cleaning from the saliva.

The reason the maxilla would be narrow can be from over-active musculature around the mouth and cheeks (thumb sucking, late pacifier), diseases and syndromes that affect growth, adverse tongue activity or obstructed airways causing a patient to breathe through their mouth instead of their nose.


This patient may seem to be the classic appearance of a character dreaming of sugar plums dancing through her head but in reality, this young lady presents with a serious malocclusion including skeletal dysplasia and a high, narrow maxilla which can and will lead to severe crowding, possible TMD and, yes, halitosis.

This child is demonstrating mouth breathing during sleep; not the decay visible on front teeth from having a constantly dry mouth.  Halitosis can start very early in development which s why children should see an accredited Orthodontist by age 6 to 7.
No matter the cause, the result can be chronic bad breathe (halitosis).  At a chemical level, Halitosis is caused by volatile sulfur compounds (VSC’s) which are formed by the proteolysis of sulfur-containing amino acids (cysteine, methionine) and proteins by the bacteria found in the oral cavity.  When someone has specific bacteria (gram-negative), acidic saliva, decreased saliva or basic gingivitis, the conditions are ripe for proteolysis.    

An illustration of the bacteria present in the oral cavity, bacteria that can turn proteins and amino acids into volatile sulfur compounds (VSC’s) which cause chronic halitosis.

So with patients experiencing bad breathe as adolescents and pre-adolescents, what does the Orthodontist look for and what can they do to help rid these young patients of this offensive and embarrassing infliction?

Your Orthodontist will evaluate your child’s upper jaw (maxilla) to see if the arch is narrow and constricted; they will assess the airways and determine whether expansion is appropriate and needed.  Expanders are generally used on pre-adolescents and early adolescents to restore narrow upper (maxillary) arches to their ideal widths.  Of course this increases space for teeth and helps to alleviate crowding but it also widens the floor of the nasal cavity and increases air flow.

In fact, according to a recent study published in the Journal of American Association of Orthodontists (Erhamza and Ozdiler, Am J Orthod Dentofacial Orthop 2018 ; 154:702-7), Rapid Palatal Expansion has been shown to significantly reduce Halitosis (measured by halimeter and organoleptic values) in patients following successful expansion at age 11 to 15.
“… according to a recent study published in the Journal of American Association of Orthodontists … Rapid Palatal Expansion has been shown to significantly reduce Halitosis”
Unfortunately DURING treatment, this may be a different story if the expander itself is not kept clean and the gum tissue massaged regularly around the appliance.  I use a bonded expander which protects the molars and provides a splint-like overlay for the jaw to shift on and settle to its natural position during expansion however this appliance certainly can cause temporary halitosis if oral hygiene instructions are not followed.  And certainly wearing appliances can led to difficulty cleaning the teeth and short-term bad breathe.  Regardless, even if the patient is not a great brusher during treatment, they still will benefit in the long run from expansion.

Several of the different sized brushes that are available to help with cleaning an expander.
If you have questions or comments concerning this or any orthodontic question, please feel free to make a complimentary new-patient appointment at either my Steiner Ranch location or my North-central Austin location on West 35th street and MoPac.
Central Austin Location, 1814 W. 35th

Steiner Ranch Location, 4302 N. Quinlan Park Rd. in Steiner Ranch
Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics and is a Diplomate of the American Board of Orthodontics.  Dr. Waters and his wife of 22 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at 


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